Angela Young had the shock of her life when China’s drugs regulator revealed that the company which produced the two vaccine shots for her 16-month-old baby also supplied 400,520 doses of substandard DPT combination vaccines to children elsewhere in the country.

Alarmed, the Beijing legal clerk consulted two agencies that specialised in arranging offshore health care, and came up with a plan: she would take her boy to Hong Kong in October when he is 18 months old for four vaccine shots. He will receive another three injections in April when he is two, plus the two combination DPT doses to protect the toddler against diphtheria, whooping cough and tetanus.

The package of vaccines will cost Young HK$5,400 (US$688), not including the air fare, hotel lodgings and food for her son and mother, which will add up to 20,000 yuan (US$3,000) in total. For the first-time mother, that amount is well worth it.

“Nothing even comes close to my biggest concern, which is the effectiveness of vaccines in China,” she said during an interview in Beijing.

Young is not alone. Families throughout China have been incensed since April by a scandal involving several of the biggest producers of vaccines and drugs that have been found to be substandard.

The loss of confidence in China’s health care could turn out to be a bonanza for Hong Kong, where 76 per cent of the 58.5 million visitors to Hong Kong last year hailed from north of the border. according to the city’s tourism data.

Most came to shop for products and services that are either unavailable, or which cost multiple times more, on the mainland. Vaccines are the latest additions to that shopping list, on top of infant formula, residential property, insurance and wealth management products.

The economic benefits to Hong Kong from the influx of these health care tourists could be long term, even if the Chinese regulator were to get a grip on the country’s vaccine safety soon. China’s dairy industry was decimated by a scandal involving melamine-laced infant powder that sickened 300,000 babies and killed six.

A decade on, there is still a thriving cottage industry of buyers who raid supermarkets in Australia, New Zealand and Hong Kong for milk powder to bring back to China for eager parents. The practice was so rampant that it led to shortages that forced Hong Kong Customs to maintain a two-can purchase limit on every visitor, to this day.

Hong Kong children need at least 17 different doses of vaccines from their birth to 12 years old, according to the city’s Childhood Immunisation Programme recommended by the Department of Health. That is not counting seven optional vaccines covering influenza and cervical cancer.

The injections are free for the city’s residents, courtesy of a public health system. For non-residents, the total bill for the entire menu of 17 doses adds up to HK$17,350. In private hospitals, the number of doses differ and the prices differ, depending on the options on offer.

The longer term benefits spill over from the medical profession. Landlords of commercial property could benefit from a boom in paediatrics, as more clinics open to serve the rising demand, said Colliers International Hong Kong’s research director, Daniel Shih.

“Central, Tsim Sha Tsui (TST), Mong Kok and Causeway Bay have the highest concentrations of medical clinics and beauty centres in Hong Kong,” said Shih. “Landlords in these districts have converted more office floors into medical floors in recent years.”

While I'm happy for Hong Kong's landlords, I'm worried about the many millions of angry Chinese parents who can't afford multiple trips to Hong Kong. The Chinese healthcare system might even have to cease outsourcing vaccine production to the private sector and make it a state-owned industry under ferocious supervision.

The government of Kerala has established a single web portal, Kerala Rescue, to coordinate communications and response to the disastrous floods the Indian state is suffering. It allows users to make requests for help, and to see where help is needed and what resources and shelters are available. A site like this should be part of the response to any natural disaster or serious disease outbreak.

The epidemiological situation of the Ebola Virus Disease dated August 17, 2018:

• A total of 90 cases of haemorrhagic fever were reported in the region, 63 confirmed and 27 probable.

• 25 suspected cases are under investigation.

• 3 new confirmed cases in Mabalako, including 1 care provider from the Mangina Reference Health Center. All of these new confirmed cases are probable and known case contacts.

• 2 deaths of confirmed cases in Mabalako.

Remarks:

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table.

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not.

On Friday, August 17, the population stormed the Makeke health center by attacking the nurse in charge of this health facility and the rest of the medical staff. The transfer of the patients to the Ebola treatment center in Mangina near Makeke in Beni territory and the insufficiency in the management of food for the patients at the aforementioned treatment center would be the basis of this uprising, according to some demonstrators.

"Whenever patients are transferred to this center, they die. According to our traditions, when a person is sick, he is brought food until healing but this is not the case here. We do not care about the sick ..." said one of the protesters.

The head of the Makeke center, Alain Kasereka Siwako, was saved thanks to the intervention of the police who could contain the protesters.

"We transfer patients to Mangina and they die there. We would like to let people know that the patients we are transferring are those who have Ebola. It's just a misunderstanding," said the head of the Makeke Health Center.

In addition, this health authority invites the people of Makeke and surrounding areas to remain calm and to continue to respect the rules of hygiene in order to fight against the spread of the disease.

"Ebola is a deadly, serious and contagious disease. So we are facing a big problem. Let's unite to fight this epidemic," he added. The security system has been strengthened to calm the situation. The Mandima district chief medical officer and the group leader held a meeting where they condemned this kind of uprising and said that it is not time to demonstrate but to speak the same language to eradicate Ebola. Calm returned.

This proves that the cure for the Ebola virus disease is not a mystery, but a reality. Some of the patients in the Mangina treatment site are being released and sent back to their homes after recovery.

Our reporter interviewed some of them who, smiling, thanked God. These cured patients also thanked the Ministry of Public Health and all its partners involved in the response to this epidemic.

"My name is KASEREKA TUMANINI. I have just been healed and released from the hospital. I have nothing to say except to thank the caregivers and the partners who activated all the mechanisms to save us. I feel very relieved ... " says a former Ebola patient.

To another to testify: "I felt stomach ache. Afterwards, it was diarrhea. But we took good care of ourselves. After a few days, I feel very fit. The advice, I address it to everyone. If you feel uncomfortable, especially diarrhea, you have to run to the hospital for treatment. I am healed now." These patients sensitize on the respect of the rules of hygiene.

Meanwhile, awareness against the spread of Ebola continues in the health zone of Mabalako. Respect for hygiene rules is considered as the first prevention measure. A team visited Mandima rural health zone in Mambasa territory where a few cases have already been confirmed, including a death recorded last Sunday. It is about a girl of ten years in the village KATANGA in the chieftaincy of Babila-Babombi. In Makeke, Njiapanda-Bella, Lukaya and Makumo villages, the population has been equipped with preventive measures. A resident of Lukaya returns what he has learned from the day's session.

PATHANAMTITTA: The situation in North Kerala continued to be very serious as thousands of houses remain marooned in water for the fourth consecutive day. There are many areas not accessible to rescue operators even now.

The stranded people virtually remain cut off from outside world with communication network getting disrupted. Without food, water or medicine, people are spending harrowing hours on top floors of their houses. There are kids, women, old citizens and patients among them. It is not known what their fate will be when rescue operators reach them.

The situation in Chengannur, Thiruvalla, Aranmula and Chalakkudy is very grave and here the rescue operations have been augmented. Continuing spells of rains are also hampering the rescue and relief operations. In Aranmula also, the situation is grim.

Two persons were found dead in Chalakkudy Muringoor Divine Dhyana Kendra. The bodies of Sivadasan (Palakkad) and Vijin Paul (Wayanad), who had drowned in strong currents of water, were recovered on Saturday.

In Chengannur, Thiruvalla and Aranmula, rescue operation has been difficult due to strong currents.

In nearby British Columbia, the province declared a state of emergency as at least 566 fires were burning this week. More than 3,000 people were under evacuation order, and a further 18,720 were on evacuation alert.

Environment and Climate Change Canada offers a map online that shows where wildfire smoke is predicted to drift.

"You can really, really smell the smoke," said Olivia Goloski, who was out walking to a car. "If I had asthma, this would be really awful. I feel bad for the people who do have asthma or respiratory conditions."

With such poor air quality, the federal weather authority is warning those most at risk include children, seniors and people with cardiovascular or respiratory illness. They're encouraged to avoid strenuous outdoor activities entirely.

Infants in particular should be protected, Johanson said, and pregnant women should be careful to avoid exposure, as well.

Militia violence in Democratic Republic of Congo has prevented aid workers from reaching some potential cases in an outbreak of Ebola that has so far killed 47 people, the World Health Organization said on Friday.

Over 2,000 people have been potentially exposed to the virus that began in North Kivu province, but the violence means officials cannot be sure if they have identified all the chains by which it is spreading in the east of the vast country.

“We don’t know if we are having all transmission chains identified. We expect to see more cases as a result of earlier infections and these infections developing into illness,” WHO spokesman Tarik Jasarevic told a news briefing in Geneva.

“The worst-case scenario is that we have these security blind spots where the epidemic could take hold that we don’t know about,” he said.

Congo’s Health Ministry said confirmed and probable cases numbered 87 in total, including 47 deaths. About 2,150 people have been identified as contacts of people infected with the disease, which causes fever, vomiting and diarrhea.

Health workers “have a huge amount of work to do to follow up on these contacts, to continue the investigations and the active search for cases, as well as to prepare the ground for the vaccination teams,” the ministry said in a statement late on Friday.

The outbreak is spreading across the lush farmlands of eastern Congo. Its epicenter is the town of Mangina in North Kivu province and it has already reached neighboring Ituri province.

August 17, 2018

Children represent an unusually high proportion of people affected by the ongoing Ebola outbreak in the eastern Democratic Republic of the Congo (DRC), UNICEF said today.

Two children have already died from the disease. The Ebola treatment centres in Beni and Mangina are currently treating six children that are infected by the disease or suspected to be. UNICEF has identified 53 orphaned children who have lost their parents to Ebola.

"The children affected by the ongoing epidemic need special attention and care,” said Dr. Gianfranco Rotigliano, UNICEF Representative in the DRC. “Women are the primary caregivers for children, so if they are infected with the disease, there is a greater risk that children and families become vulnerable."

The UN children’s agency and its partners have trained 88 psychosocial workers to assist and comfort children in centres, and to support children who have been discharged as free of Ebola, but may be at risk of stigmatization within the community. The psychosocial workers organize awareness-raising activities to facilitate the return of these children to their communities.

"The impact of the disease on children is not limited to those who have been infected or suspected,” said Rotigliano. “Many children are faced with the illness or death of their parents and loved ones, while some children have lost large parts of their families and become isolated. These children urgently need our support".

The organisation seeks and supports foster families for these children, and also provides them with psychosocial care and food assistance.

The epidemiological situation of the Ebola Virus Disease dated August 16, 2018:

• A total of 87 cases of haemorrhagic fever have been reported in the region, 60 confirmed and 27 probable.

• 21 suspected cases are under investigation.

• 9 new confirmed cases in Mabalako, including 2 care providers from the Mangina Reference Health Center. All of these new confirmed cases are probable and known case contacts.

• 4 deaths from confirmed cases in Mabalako.

* An analysis of the databases revealed that a non-case discharged from the Beni Ebola treatment center had been registered as a death. Thus, there are 3 deaths of confirmed cases in Beni, not 4.

Remarks:

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table.

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not.

News of the response

Acceleration of the response to the epicenter of the epidemic

• On Friday, August 17, 2018, the Minister of Health, Dr. Oly Ilunga Kalenga, visited the teams deployed in Mangina (Mabalako Health Zone). In particular, he spoke with the additional surveillance teams sent in reinforcements who arrived since yesterday on site. With 2,157 contacts already registered, they have a huge amount of work to do to follow up on these contacts, to continue the investigations and the active search for cases, as well as to prepare the ground for the vaccination teams.

The Minister then visited the new Mangina ETC which has a capacity of 50 beds. However, due to the rapid increase in confirmed cases, the coordination is considering the construction of a second ETC in Mangina.